An evaluation of the performance and acceptability of three LED fluorescent microscopes in Zambia: lessons learnt for scale-up

Eleanor R Turnbull, Kaunda Kaunda, Jennifer B Harris, Nathan Kapata, Mweemba W Muvwimi, Annika Kruuner, German Henostroza, Stewart E Reid, Eleanor R Turnbull, Kaunda Kaunda, Jennifer B Harris, Nathan Kapata, Mweemba W Muvwimi, Annika Kruuner, German Henostroza, Stewart E Reid

Abstract

The World Health Organization recommends the roll-out of light-emitting diode (LED) fluorescent microscopes (FM) as an alternative to light microscopes in resource-limited settings. We evaluated the acceptability and performance of three LED FMs after a short orientation among laboratory technicians from government health centers in Zambia. Sixteen technicians with varied light microscopy experience were oriented to FMs and divided into groups; each group read a different set of 40 slides on each LED FM (Primo Star iLED™, Lumin™, FluoLED™) and on a reference mercury-vapor FM (Olympus BX41TF). Slide reading times were recorded. An experienced FM technician examined each slide on the Olympus BX41TF. Sensitivity and specificity compared to TB culture were calculated. Misclassification compared to the experienced technician and inter-rater reliability between trainees was assessed. Trainees rated microscopes on technical aspects. Primo Star iLED™, FluoLED™ and Olympus BX41TF had comparable sensitivities (67%, 65% and 65% respectively), with the Lumin™ significantly worse (56%; p<0.05). Specificity was low for trainees on all microscopes (75.9%) compared to the experienced technician on Olympus BX41TF (100%). Primo Star iLED™ had significantly less misclassification (21.1% p<0.05) than FluoLED™ (26.5%) and Lumin™ (26.8%) and significantly higher inter-rater reliability (0.611; p<0.05), compared to FluoLED™ (0.523) and Lumin™ (0.492). Slide reading times for LED FMs were slower than the reference, but not significantly different from each other. Primo Star iLED™ rated highest in acceptability measures, followed by FluoLED™ then Lumin™. Primo Star iLED™ was consistently better than FluoLED™ and Lumin™, and performed comparably to the Olympus BX41TF in all analyses, except reading times. The Lumin™ compared least favorably and was thought unacceptable for use. Specificity and inter-rater reliability were low for all microscopes suggesting that a brief orientation was insufficient in this setting. These results provide important data for resource-limited settings to consider as they scale-up LED FMs.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. Government of the Republic of Zambia, Central Statistical Office, 2011. The Monthly, January 2011.
    1. World Health Organization. Global Tuberculosis Control: WHO Report 2010. 2010. Geneva, Switzerland. WHO/HTM/TB/2010.7.
    1. Harris JB, Hatwiinda SM, Randels KM, Chi BH, Kancheya NG, et al. Early lessons from the integration of tuberculosis and HIV services in primary care centers in Lusaka, Zambia. Int J Tuberc Lung Dis. 2008;12:773–779.
    1. Mukadi YD, Maher D, Harries A. Tuberculosis case fatality rates in high HIV prevalence populations in sub-Saharan Africa. AIDS. 2001;15:143–152.
    1. Ba F, Rieder HL. A comparison of fluorescence microscopy with the Ziehl-Neelsen technique in the examination of sputum for acid-fast bacilli. Int J Tuberc Lung Dis. 1999;3:1101–1105.
    1. Mugusi F, Villamor E, Urassa W, Saathoff E, Bosch RJ, et al. HIV co-infection, CD4 cell counts and clinical correlates of bacillary density in pulmonary tuberculosis. Int J Tuberc Lung Dis. 2006;10:663–669.
    1. World Health Organization. : Global Tuberculosis Control - epidemiology, strategy, financing: WHO Report 2009. 2009. Geneva, Switzerland. WHO/HTM/TB/2009.411.
    1. Steingart KR, Henry M, Ng V, Hopewell PC, Ramsay A, et al. Fluorescence versus conventional sputum smear microscopy for tuberculosis: a systematic review. Lancet Infect Dis. 2006;6:570–581.
    1. Cattamanchi A, Davis JL, Worodria W, den Boon S, Yoo S, et al. Sensitivity and specificity of fluorescence microscopy for diagnosing pulmonary tuberculosis in a high HIV prevalence setting. Int J Tuberc Lung Dis. 2009;13:1130–1136.
    1. Prasanthi K, Kumari AR. Efficacy of fluorochrome stain in the diagnosis of pulmonary tuberculosis co-infected with HIV. Indian J Med Microbiol. 2005;23:179–181.
    1. Toman K. What are the advantages and disadvantages of fluorescence microscopy? In: Frieden T, editor. Toman's tuberculosis: case detection, treatment, and monitoring—questions and answers. 2nd ed. Geneva: World Health Organization; 2004. pp. 31–34.
    1. World Health Organization. Fluorescent Light Emitting Diode Microscopy for Diagnosis of Tuberculosis. 2010. Policy Statement. March 2010. Accessed 16 February 2011.
    1. Trusov A, Bumgarner R, Valijev R, Chestnova R, Talevski S, et al. Comparison of Lumin LED fluorescent attachment, fluorescent microscopy and Ziehl-Neelsen for AFB diagnosis. Int J Tuberc Lung Dis. 2009;13:836–841.
    1. Marais BJ, Brittle W, Painczyk K, Hesseling AC, Beyers N, et al. Use of light-emitting diode fluorescence microscopy to detect acid-fast bacilli in sputum. Clin Infect Dis. 2008;47:203–207.
    1. Cattamanchi A, Huang L, Worodria W, den Boon S, Kalema N, et al. Integrated strategies to optimize sputum smear microscopy: a prospective observational study. Am J Respir Crit Care Med. 2011;183:547–551.
    1. Mizuno K, Chikamatsu K, Aono A, Azuma Y, Yamada H, et al. [Clinical evaluation of acid-fast smear examination with light emitting diode fluorescent microscopy]. Kekkaku. 2009;84:627–629.
    1. Hanscheid T, Ribeiro CM, Shapiro HM, Perlmutter NG. Fluorescence microscopy for tuberculosis diagnosis. Lancet Infect Dis. 2007;7:236–237.
    1. Minion J, Sohn H, Pai M. Light-emitting diode technologies for TB diagnosis: what is on the market? Expert Rev Med Devices. 2009;6:341–345.
    1. Van Deun A, Chonde TM, Gumusboga M, Rienthong S. Performance and acceptability of the FluoLED Easy module for tuberculosis fluorescence microscopy. Int J Tuberc Lung Dis. 2008;12:1009–1014.
    1. Hung NV, Sy DN, Anthony RM, Cobelens FG, van Soolingen D. Fluorescence microscopy for tuberculosis diagnosis. Lancet Infect Dis. 2007;7:238–239; author reply 239–240.
    1. Miller AR, Davis GL, Oden ZM, Razavi MR, Fateh A, et al. Portable, battery-operated, low-cost, bright field and fluorescence microscope. PLoS One. 2010;5
    1. Hanscheid T. The future looks bright: low-cost fluorescent microscopes for detection of Mycobacterium tuberculosis and Coccidiae. Trans R Soc Trop Med Hyg. 2008;102:520–521.
    1. Albert H, Manabe Y, Lukyamuzi G, Ademun P, Mukkada S, et al. Performance of three LED-based fluorescence microscopy systems for detection of tuberculosis in Uganda. PLoS One. 2010;5:e15206.
    1. Bonnet M, Gagnidze L, Githui W, Guerin PJ, Bonte L, et al. Performance of LED-based fluorescence microscopy to diagnose tuberculosis in a peripheral health centre in Nairobi. PLoS One. 2011;6:e17214.
    1. Government of the Republic of Zambia, Ministry of Health (2005), National Health Strategic Plan: 2006–2010. 2005. Ndeke House, Lusaka, Zambia.
    1. Affolabi D, Torrea G, Odoun M, Senou N, Ali Ligali M, et al. Comparison of two LED fluorescence microscopy build-on modules for acid-fast smear microscopy. Int J Tuberc Lung Dis. 2010;14:160–164.
    1. World Health Organization. Laboratory Services in Tuberculosis Control Part II Microscopy. 1998. WHO WHO/TB/98.258.
    1. Siddiqi SH, R-G S. Foundation for Innovative New Diagnostics: MGIT Procedure Manual. 2006. Geneva, Switzerland.
    1. Carl Zeiss Microimaging GmbH. 2011. Primostar iLED, . Accessed 26th May 2011.
    1. LWScientific. 2011. Accessed 26th May 2011.
    1. Fraen Corporation. 2011. . Accessed 26th May 2011.
    1. Foundation for Innovative New Diagnostics. 2008. Demonstration Project iLED Training Manual, Version 1.0, 1st September 2008.
    1. Foundation for Innovative New Diagnostics. FIND prices for Primostar iLED and Country List. 2010. . Accessed 16th June 2011.

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